• Eellan Sivanesan, David A Lubarsky, Chaturani T Ranasinghe, Constantine D Sarantopoulos, and Richard H Epstein.
• Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Central 300, 1611 NW 12th Ave, Miami, FL 33136, United States. Electronic address: esivanesan@med.miami.edu.
• J Clin Anesth. 2017 Sep 1; 41: 92-96.

Study ObjectiveTo determine if open-access scheduling would reduce the cancellation rate for new patient evaluations in a chronic pain clinic by at least 50%.DesignRetrospective, observational study using electronic health records.SettingChronic pain clinic of an academic anesthesia department.PatientsAll patients scheduled for evaluation or follow-up appointments in the chronic pain clinic between April 1, 2014, and December 31, 2015.InterventionsOpen-access scheduling was instituted in April 2015 with appointments offered on a date of the patient's choosing ≥1 business day after calling, with no limit on the daily number of new patients.MeasurementsMean cancellation rates for new patients were compared between the 12-month baseline period prior to and for 7months after the change, following an intervening 2-month washout period. The method of batch means (by month) and the 2-sided Student t-test were used; P<0.01 required for significance.Main ResultsThe new patient mean cancellation rate decreased from a baseline of 35.7% by 4.2% (95% confidence interval [CI] 1.4% to 6.9%; P=0.005); however, this failed to reach the 50% reduction target of 17.8%. Appointment lag time decreased by 4.7days (95% CI 2.3 to 7.0days, P<0.001) from 14.1days to 9.4days in the new patient group. More new patients were seen within 1week compared to baseline (50.6% versus 19.1%; P<0.0001). The mean number of new patient visits per month increased from 158.5 to 225.0 (P=0.0004). The cancellation rate and appointment lag times did not decrease for established patient visits, as expected because open-access scheduling was not implemented for this group.ConclusionsAccess to care for new chronic pain patients improved with modified open-access scheduling. However, their mean cancellation rate only decreased from 35.7% to 31.5%, making this a marginally effective strategy to reduce cancellations.Copyright © 2017 Elsevier Inc. All rights reserved.

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